=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538070263
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAMARA ABIGAIL CAVAZOS RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2026
-----------------------------------------------------
Last Update Date | 09/14/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 N JEBAVY DR
-----------------------------------------------------
City | LUDINGTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49431-1921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-787-2293
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7146 N 120TH AVE
-----------------------------------------------------
City | HART
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49420-8011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-343-4629
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
-----------------------------------------------------
License Number | 4704416010
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------